Provider Demographics
NPI:1992189229
Name:PARUNGAO, LOIDA
Entity Type:Individual
Prefix:DR
First Name:LOIDA
Middle Name:
Last Name:PARUNGAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 SANTA MONICA BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1260
Mailing Address - Country:US
Mailing Address - Phone:323-461-5696
Mailing Address - Fax:323-461-5268
Practice Address - Street 1:5300 SANTA MONICA BLVD STE 403
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1260
Practice Address - Country:US
Practice Address - Phone:323-461-5696
Practice Address - Fax:323-461-5268
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice